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PL-11-1797Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 164985 Scheduled Inspection Date: December 05, 2011 Inspector: Hernandez, Rafael Owner: MCCREADY, JAMES Permit Number: PL -9 -11 -1797 Job Address: 1399 NE 103 Street Miami Shores, FL Project: <NONE> Contractor: TECO PEOPLES GAS SYSTEM Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number Parcel Number 1132050300190 Phone: (305)957 -3857 Building Department Comments PROPOSED TO DIRECTIONAL BORE NEW 3/4" PLASTIC GAS LINE SERVICE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 02, 2011 For Inspections please call: (305)762 -4949 Page 9 of 46 a,\ (.-- -5 „LAcr. Public Works Permit Application FBC 2004 Permit Type: Public Woi(cs WATER Miami shores Village Public Works Department 10050 N.E. 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Far (305) 756.8972 Owners Name (Fee Simple Titleholder) Jeol i %'y9 eafe er0/f Owners Address / 9 f AO. E / 3 AV s� Clty� lJ��? Tenant/Lessee SEP 2 92011 Phoned: 305- SAi 4/9'61 7r' Job Address (where the work is being done) 18 4 'e 10 3 Phoned: Zip 3.3'3 City Miami Shod Village County "Band Dade Is Building Historic *y Designated: YES NO ZIP 33 ®3J Contractors Company Name drzed ezeks e Sa7, u'eSr CereL Contractors Address City Ad 07,1 ��a o state r'® Phone #. 26S— 2a /,75 `. 03 WS' V Zip a E Q'_e5 �a pi S Phoned: F % ®' 3 7 Arddtmx/Englneefs Name (B applicable) ¢,� Lineal, Footage Of Work: a 0 e'd 13/4°) $ Veins of Work For this Permit gr. 700'• Type of Work Describe Work: Submittal Fee $ Notary $ Scanning $ Code Enforcement $ ❑ Addition �j n Alteration New ❑ Repa'v/Replac�ej ❑ 1p!mofltion .- a®y021 £ /,2E,, i.. � ..�iiSsrc.. ��.P / �aGrs�- /97V, PP2,.7 m, 4a .................+++ Fees Total Fee Now Due $ (Continued on opposite side) Permit Fee $ Tra}ninglEducation Fee $ Radon $ Zoning Bond $ Structural Plan Review $ CCF $ CO/CC Technology Fee $ /Le 4s-e9 Bonding Company% Name (if applicable) Bonding. Company's Address WA City State Mortgage Lenders Name (if applicable) WA Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and Installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating contitmc ion in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CbNDMONERS, ETC .... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work veil be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant As a condition to this Issuance of a Public Works pem►it with an estimated value exceeding $2800, the appfrcant must promise bh good faith that a copy of the notice of commencement and construction Gen law brochure will be', • red to the person whose property Is subject to attachment. Also, a certified copy ofthe recorded notice of ccumnenannerd must be , . at Pre job site for/he first hhspecfon which occurs seven (7) days after the building penult is.issued In the. absence of such posted notice, the inspection will not be approved and a relnspection fee will be charged Signature Owner or Agent Signature Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was adcnowtedged before me this day of , 20 , by day of . 20 , by who is personally known to me or who has produ • r Who is personalty know to me or has produced NOTAR Sign: Print: My Commission Expires: as identification and NOTARY PUBLIC: APPLICATION APPROVED BY: 11/17/2005 Public Works Director or his designee. AM120 CERTIFICATE OF LIABILITY INSURANCE " ` ` trOD 'N) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER MCGRIFF, SEIBELS &WILLIAMS, INC. P.O. Box 10265 Birmingham, AL 35202 CONTACT NAME: PHONE 800 -476 -2211 (NC. No. Ert): E-MAIL ADDRESS: FAX _(NC, No): INSURER(S) AFFORDING COVERAGE NAIC INSURER A :Associated Electric & Gas Ins. Svcs. INSURED Peoples Gas System TECO Energy, Inc. P.O. Box 111 Tampa, FL 33601 INSURER B :Liberty Insurance Corp. INSURER c :Zurich American Insurance Company 16535 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:EE74Y5HU REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE ADDL JNSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM!DD1YYYY) LIMITS A GENERAL — LABILITY COMMERCIAL GENERAL LIABILITY X0521AIA11 Self- Insured Retention $1,000,000 07/01/2011 07/01/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ X I CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP /OP AGG $ GEML AGGREGATE LIMIT APPLIES PER: —I POLICY n JERC n LOC $ A AUTOMOBILE — LABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS AWNED X0521AIA11 Self- Insured Retention $250,000 07/01/2011 07/01/2012 COMBINED SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per DAMAGE $ A X UMBRELLALIAB EXCESS LAB X OCCUR CLAIMS -MADE X0521AIA11 07/01/2011 07/01 /2012 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED 1 1 RETENTION $ A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I I (Mandatory In NH) If yes desaibe under DESCRIPTION OF OPERATIONS below N / A EWS931859700 X0521A1A11 - 07/01/2011 07/01/2012 X I TORY LIMITS UNITS I I �R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B EXCESS WC Excess Workers' Compensation EW564N004918121 07/01/2011 07/01/2012 Each Accident or Each Employee for Disease $ $ 35,000,000 $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Excess Liability policy provides insurance In excess of Peoples Gas System's Self- Insured Retention as stated above. WC Statutory Limit is excess of $35,000,000 (insured by Liberty Insurance Corporation) CERTIFICATE HOLDER CANCELLATION City of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Page 1 of 1 © 1988-2010 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2010/05) The ACORD name and Vogt are registered marks of ACORD Ta)13 •:-4111024.4111'14 TO**, * Seat L,3$ CERIV-V,ATE CCNIVEIEWY GA SilS North Miami ,Ctntrctcr ID Number: 16L,. 1.0 Town ofBay Harbrr sLrd Conrctc O Number: CONTO6132OO4 -a5 477336-3 BUSINESS NAME/ LOCATION PEOPLES GAS SYSTEM INC MUNICIPALITIES LOC 33888 FIRST-CLASS U.S. POSTAGE PAW MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL - DO NOT PAY RENEWAL REc No_ 498320-2 OWNER PEOPLES GAS SYSTEM INC Sec. Tir et Business AGGR.SO FT I COMMERCL/INDUST/OFFICE SPACE 3304 THIS IS 136E CAL RUMNESS TAX RECEIPT, IT DOES NOT PERMIT THE HOLDER TC VIOLATE ANY EXISTING REGULATORY' OR ZONING LAWS OF THE COUNTY OR Dann- NC ODES TT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED i3Y LAW. THIS IS NM A CERTIFICATION QF THE HOLDER'S CRIALIFICA- DONS PAYMENT RECEIVED MIANR-DADE COUNTY TA% COLLEMMR_ 08/02/2011 60040000550 000075.00 PEOPLES GAS SYSTEM INC AT' z TAX DEPARTMENT PO BOX 2562 TAMPA FL 33601 RtVtrf.rana31751%.3.MThatartat, ''''Vt7Z2Zat, tdaorattatat att..ottc.r "attottazot a a ,attte,tattt, WA:4*a Steven MitcheII •has attended the Florida Advanced .Re•fresher Course: • • . ,,a,::t:A,.•Itm.3,mxtmiiim,m,ms,mo•ax000gwwi,mFtwamotfavmogqit,:E.• AMERICAN TRAFFIC SAFETY SERVICES ASSOCIATION svEg Rpm um LivEs This is to affirm that September 10, 2009 Date Ft. Laude dale, FL Location Mr. Steven Mitchell ID #37 has satisfactorily completed the Florida Advanced Work Zone Traffic Control Refresher Course Date Completed:9/1012009 Status:Passed Final Location:Ft. Lauderdale, FL InstructorMs.. althea-me G. Watt Date Refresher Course Required.9/1012013 ata"ita.7""2"7" .!;a1 Training & Products Dept. Director \AHt AD," ...., r'Space Table i 250' t: )40.4ilts 'pt 5ee Table; 7 Device. Spacing -Toper `See. -Table I. . DISTAArE BETWEEN 51a .Spacing rf. mph1 . 9 40 or :less 200 .200 2000. C0 5 353 _.350 350 t ; 50 - I'Sg3-j =5 2 00 500 25Q i. _ c ;preoter r2540l 40 1000 .000- WORK. MILE sign. may Ce used as: on alternate to : the ROAD * R4. 4(0A.^ 5007Pe.yaha ._.he: RQA0 WORK' AHEA or midway, be twaen- signs wtr ,eit'0.. a .BE.. PREPARED T.O.'STOP sign m-ay be omitted .for weeds of 45 .MR4 or less t C" T amir': SPACING i:' ax. :.Dietarce - c5eteaen Devices eft.) ' h ('ones ar ripe ole 1 "or or Type if ruavi, lUtOrker9 isogicodHS or Vertical l ?wDrums :.toper Tangent Taper , Tangent i . 20 50:. I 20 50 50 1 20 100 I YLS • x Arena ?" k. 5 `4n.).. 0.ron0 +_ Ffog And Tyco -5- .Light Ch aiseag'Device- (Soo index No. 600) 15 - Wng.ri: Zone Sian. efee =logger ?toted Flogger Assistance Devices Vt. : -With.- vote - i._zne Ideniificaaorr -t. _Direct'ion of T'o f1•_` Work. aperofions- stfdllbe coafineti'to 010 rrtgf ?n; lane, leaving the- opposite lane -.95580 2. Additional oneemoy'controtrnoy: be effected'. feliowi'g.."re308' C 1 F1aanoorrying- :vehicle. !21 Offibioi.w Male; (3) pifdt vehicles; Of)- F.ratfk 5lancele. When ftltgger0 are -t!:c sole..h 06.00V n? ane-nn,,,. control, the..'1uggers > :3hdApe - in'Skint of watt -- :other cr in d'•sct :.corennn,eeifie ot- elf times. 3: The ONE 1tANE.t9IJADreigns ore :za I>A iuNy- cai:.ered grad the _FCAGOE`R s`mgds. either removed' nr covered:,when ',:work is' -being performed :aid -the higbwri -is. open-fa -t o -wuy ,raft c, . 4.. When o side rade :intersects the .highway lettitnt tho TrO zone.-- ..additional':TTC devices shdHbe. placed -in accordance with other..vpePie<rble- 1552 .Indexes, fE5 5. The lwo channeiizing devices directly in front c6, tt work 016,0 and the one _chcnneIZing device directly at the end of the work area may be omitted provided vehicles in the work area have(1/9M-intensity . 110ting, floshina oscillating_ or strobe lights aperoMme 6; For general TCZ requirements and odd t c.. : t farmetion. refer to .Index No. 0600. DUR4 flON NOTES .I. ROAD WORK AHEAD and the BE ".R_PAREO 75 STQ- signs May omitted if alien' the following conditions are met, -a) Work operations are 60 minutes or less. 5) Speed limit is 45 ,rob or less e) No sight obstructions to vehicles approaching the work area for o distance equei to the buffer space. d' Vehicles in the work area hove bgh ntensity. :rotating, *555/08, oscillating, or strobe fights opera;hg. e) Volume and complexity of the roadway nos been cansidefed. Whet: 1 constraints. e- nro eogt . CONDIT 1D WHERE n WORKERS UP THEye ElVaRDACH THE AREA 73- THE CENTERLINE OUTS/L_ 714104,ANE d WO 0 FAO`? Aeai . Standamis §E' ' { x�o i :4Y WORK WITHIN THE TRAVEL WAY .' ..w 1434 1 N•F /oSinner- NOTES CONSTRUCTION 1. LQCATE AND PROTECT ALL UTILITIES IN ACc /}F CONSTRUCTION. SUNSHINE # 1-8OO-43,1-4/.�' 2. RESTORE ALL AREAS TO PRIOR CONDITIONS J. ALL CONSTRUCTION TO FOLLOW JURISDICTIONAL GOVERNMENT AND TPG STANDARDS. SOD RESTORATION DETAIL SCALE: NOT TO SCALE ws1oonoSTREET cr PROP 2" PE BORE |z — 9 6 CROSS SECTION 18" MINIMUM LOT 11 BLOCK 6 N P/L LOT � ������������ .BLOCK 6 1399 NE 1 PROPOSED 3y4- PROPOSED METER N R/W � LOT 10 BLOCK 6 '- STREET - DRIVE WAY ~ --~ N R/W .-.-_....^. 0 'AS__ s n/W ---'----7---'------'----- SANITARY SEWER E INTO Exis-nm 2" B.S. GAS MAIN BLOCK 5 ICALL 48 HOURS BEFORE YOU DM IN FLORIDA � 4 |------�—^--------------------- reco/Pso��sa�a� w rcr.��own 1399 NE 103RD ST. MyAKA! SHORES ;44°P�����F�\�/��E